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Fear pushing more immigrants to avoid seeking medical care

Immigrant families in Ventura County listen during a community meeting in November held to reassure them they are safe to seek healthcare, regardless of immigration status.(Photo: Claudia Boyd-Barrett for California Health Report)

Unless it's an absolute emergency, Tere, a 35-year-old mother of five children in Oxnard, tries not to leave the house these days.

As an immigrant without legal status, she's terrified she could get stopped and deported while driving to the store or to the doctor's office. Tere, who asked that her full name not be used for her protection, said she doesn't like to skimp on medical care for her kids. But when it comes to her own health, she'll try to muscle through on her own to avoid going out. Recently, she waited almost two weeks to seek help for an ear infection, she said. By that time the pain was so bad she had to go to the emergency room.

As national rhetoric and policies around immigration become increasingly hostile under the Trump administration, health care providers and organizations that work with immigrants are encountering more people like Tere. Immigrants who are undocumented or have family members in the country illegally have become more wary about seeking medical help, both at clinics and hospitals and also through government programs such as Medi-Cal or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), advocates and health providers said.

"Since last November (2016) there's been a fear that has entered our immigrant communities, and we've seen it personally," said Genevieve Flores-Haro, associate director of the Mixteco/Indigena Community Organizing Project in Ventura County. The community organization helps indigenous Mexican families access health care, sign up for Medi-Cal and learn about health-related issues such as parenting and mental wellbeing.

"Even within our own services, folks that wanted to talk to us, they'll give us their name but not their phone number," Flores-Haro said. "So we're having to do reassurance, that it's ok, it's safe, nothing's going to happen."

A recent study by the Kaiser Family Foundation found that fear of deportation is widespread and pushing some immigrant families to decrease health care use. Researchers interviewed 100 parents in immigrant families nationwide, including in Los Angeles, Oakland, Fresno and San Diego. They also spoke with pediatricians and clinics that service immigrants.

The researchers heard reports of immigrant families visiting the doctor less frequently, not following up on prenatal care or referrals to outside providers, and changing how they access care in an effort to reduce their risk of being tracked by immigration authorities. For example, one pediatrician said parents are opting for walk-in visits instead of providing information over the phone to schedule an appointment, according to the report. Another said families no longer answer the phone or open their doors for home health visits.

Although many parents interviewed said they continued to enroll their children in government healthcare programs, the report did find evidence that some immigrant families have become more reluctant to sign up for Medicaid, WIC and the Supplemental Nutrition Assistance Program (SNAP) because they fear the information they provide could be passed along to immigration officials.

Another report by the Alameda County Public Health Department said that clinics serving primarily immigrants and Latinos were seeing evidence of pregnant clients not seeking early prenatal care, increasing the risk of complications for mother and child. Meanwhile, the staff at the department’s Women, Infants and Children (WIC) program have heard from clients dropping out of the program because they're worried it could jeopardize their eligibility for citizenship, and that information shared with the program would be turned over to immigration enforcement officials, the report stated.

Public Information Officer Sherri Willis said it's challenging for health care providers to fully reassure clients they are safe, given that they have no control over what might happen to them outside of the clinic or hospital.

"It's not so much what happens at the doctor's office as the journey to the doctor's office and going back," she said. "We cannot comment on …how safe it is to get to those facilities and get back home."

At MICOP, the number of families enrolling or re-enrolling their children in Medi-Cal – the state version of Medicaid – has dropped by half compared to last year, Flores-Haro said.

"At our busiest last year we were processing 300 applications per month, and that dropped this year to an average of about 150," she said. "We're talking even families where their children are citizens not opting to enroll or re-enroll, for fear of how the information is going to be traced back to them."

So far, this reported reluctance does not appear to be impacting statewide Medi-Cal enrollment numbers. The California Department of Health Care Services, which oversees the plan, said enrollment in Medi-Cal has remained strong since May 2016 when undocumented children under age 19 became fully eligible for the program.

Nevertheless, the concern that immigrants are cutting back on health care has prompted some counties to hold meetings reassuring undocumented community members they are safe to go to the doctor. In Alameda County, where one in three residents is an immigrant, local health officials and political leaders held such a meeting in October. Ventura County's MICOP followed suit in November, inviting community organizers and leaders from the county health department and medical clinics to address about 200 immigrants, most of them farmworkers.

"Go to your medical appointments. Take your kids to their medical appointments. Your health and your kids' health are very important," urged community organizer Aracely Preciado in Spanish. "I know you share personal information…but that's just for your health records. They're not going to give that information to immigration authorities to deport you."

Sandra Young, a family nurse practitioner at the Las Islas health clinic in south Oxnard, was among the speakers. She said that lately many of her indigenous clients have not been coming to appointments.

"Particularly when there is any kind of (immigration enforcement) activity in the county, people literally retreat to their homes," she said. "I talk to people regularly and I say, 'Hey, I haven't seen your kid.' And they say, 'Well, we're not going outside right now, we're afraid.'"

The problem reaches beyond individuals, Young said. If people don't seek medical care, others in the community are at greater risk becoming sick too, she said. The arrival of flu season adds to that danger, especially among children, pregnant women and the elderly who can experience dangerous complications from the virus, she said.

Putting off medical care can also lead to dangerous complications, Flores-Haro said, who added that one community member recently died from a flu-like illness after delaying medical attention.

"I'm worried," she said. "If we don't let the community know they can safely access health care in Ventura County, the worry extends to what could happen."

The California Health Report is a statewide nonprofit news service that covers health and health policy. Read more at calhealthreport.org.